Search Results (888)

Background: Peer-led Active Rehabilitation Camps (ARC) aim to enhance functional independence and self-management among people with spinal cord injury (SCI). In Poland, where access to specialized spinal units and lifelong follow-up is limited, these programs may help address key health priorities—mobility, bowel and bladder management, sexual well-being, and upper-limb function. This study examined whether participation in ARC helped individuals achieve these priorities and identified factors associated with outcomes. Methods: This prospective cohort study, part of the Inter-PEER project, included 125 adults with SCI who attended one of 16 consecutive ARCs in Poland (2023–2024). Eligible participants used a manual wheelchair, were aged ≥ 16 years, and could complete written questionnaires. Data were collected at camp start (T1), completion (T2), and 3-month follow-up (T3) using surveys and wheelchair skills assessments. Validated instruments (SCIM-SR, MSES, QEWS, WST-Q, LiSat-11) were used and were aligned with the four priority domains. Associations with demographic and injury variables were examined using multivariate regression analyses. Results: Participants showed significant gains across priorities during the 10-day ARC. Mobility improved on all wheelchair-skill measures (e.g., QEWS + 2.6 points, p < 0.001), with most gains sustained at T3. Among participants with tetraplegia, self-care and hygiene scores increased by 24% and remained elevated at follow-up. Confidence in achieving a satisfying sexual relationship increased by camp end and was accompanied by higher sexual-life satisfaction at T3. Regression analyses found only modest associations between outcomes and demographic or injury characteristics. Conclusions: Participation in peer-led ARC programs was associated with rapid, clinically meaningful improvements in several health domains prioritized by people with SCI, especially upper-limb function, sexual well-being, and wheelchair mobility. Our findings highlight the value of integrating structured, peer-based community programs into the continuum of SCI rehabilitation. Full article

Background: Recovery following incomplete spinal cord injury (iSCI) remains challenging, with conventional rehabilitation often emphasizing compensation over functional restoration. As most new spinal cord injury cases preserve some motor or sensory pathways, there is increasing interest in therapies that harness neuroplasticity. Robotic exoskeletons provide a promising means to deliver task-specific, repetitive gait training that may promote adaptive neural reorganization. This feasibility study investigates the feasibility, safety, and short-term effects of exoskeleton-assisted walking in individuals with degenerative iSCI. Methods: Two cooperative male patients (patients A and B) with degenerative iSCI (AIS C, neurological level L1) participated in a four-week intervention consisting of one hour of neuromotor physiotherapy followed by one hour of exoskeleton-assisted gait training, three times per week. Functional performance was assessed using the 10-Meter Walk Test, while gait quality was examined through spatiotemporal gait analysis. Vendor-generated surface electromyography (sEMG) plots were available only for qualitative description. Results: Patient A demonstrated a clinically meaningful increase in walking speed (+0.15 m/s). Spatiotemporal parameters showed mixed and non-uniform changes, including longer cycle, stance, and swing times, which reflect a slower stepping pattern rather than improved efficiency or coordination. Patient B showed a stable walking speed (+0.03 m/s) and persistent gait asymmetries. Qualitative sEMG plots are presented descriptively but cannot support interpretations of muscle recruitment patterns or neuromuscular changes. Conclusions: In this exploratory study, exoskeleton-assisted gait training was feasible and well tolerated when combined with conventional physiotherapy. However, observed changes were heterogeneous and do not allow causal or mechanistic interpretation related to neuromuscular control, muscle recruitment, or device-specific effects. These findings highlight substantial inter-individual variability and underscore the need for larger controlled studies to identify predictors of response and optimize rehabilitation protocols. Full article

Despite the growing interest in physiological stress monitoring, an objective measure of stress is currently lacking, especially in clinical and rehabilitation contexts. With the emerging integration of artificial intelligence (AI) in data analytics, heart rate variability (HRV) has gained attention as an effective biomarker; however, the literature remains fragmented across disciplines, stress types, and methodological approaches. This scoping review aims to investigate how AI techniques are applied to HRV analysis for stress detection and prediction in adult populations. Although this review does not focus on a specific subtype of stress, its primary objective is to explore the current methodological state of the art as reported in the literature, without restrictions on stress typology. Following PRISMA-ScR guidelines, a systematic search was conducted across PubMed, Scopus, and Google Scholar for studies published between 2005 and 2025, using MeSH terms including “HRV”, “Rehabilitation”, “SCI” (for Spinal Cord Injury), “Stress”, “Sympathetic”, “Parasympathetic”, “Non-linear”, “Gamification”, “AI” and “Machine Learning”. Inclusion criteria targeted adult human populations and studies employing HRV features as input for AI and machine learning techniques for psychophysical stress assessment. Of the 566 records identified, 15 studies met the eligibility criteria. The reviewed studies exhibit substantial heterogeneity in terms of settings, populations, sensors, and algorithms with most employing supervised methods (e.g., random forest, support vector machine), alongside several applications of deep learning and explainable AI. Only one study focused specifically on physiological stress, none focused on SCI populations, and rehabilitation-related research was scarce, thereby underscoring important gaps in the current literature. Overall, HR variability analysis, especially when combined with artificial intelligence techniques, represents a promising approach for stress assessment; however, the field is methodologically fragmented and clinically underdeveloped in critical areas, underscoring the need for a multidisciplinary methodological framework. Full article

Objectives: Spinal cord injury (SCI) disrupts the microstructure of the spinal cord, triggers reorganization of the brain network, and causes motor deficits. However, the temporal dynamics and interrelationships of these alterations remain unclear. Methods: Eight monkeys underwent spinal cord hemisection and were randomly assigned to either the SCI-only group or the treatment group that received neurotrophin-3-chitosan implants. Longitudinal brain structural/resting-state magnetic resonance imaging and spinal cord diffusion tensor imaging (DTI) were conducted. Concurrently, hindlimb motor function was assessed. The brain network topology was characterized through graph theory. The generalized additive mixed model (GAMM) was employed to analyze the longitudinal trajectories of network metrics, while the linear mixed-effects model (LMM) was used to evaluate the moderating effect of treatment on correlations between network metrics and motor/DTI parameters. Results: The SCI-only group exhibited sustained functional network segregation, aberrant structural topology, and lower fractional anisotropy (FA). These findings collectively reflect chronic maladaptive plasticity. In the treatment group, the therapy not only enhanced white matter integrity, reflected by increased FA values, but also reduced the clustering coefficient (Cp) in brain structural network, indicating a shift away from maladaptive segregation. Critically, the LMMs further revealed that treatment moderated the pathological correlations between global efficiency (Eg), local efficiency, Cp, and locomotor parameters. Moreover, spinal FA exerted a significant main effect on Eg of brain functional networks. Conclusions: These findings suggest that treatment-induced brain reorganization underlies motor function following SCI, and progressive brain reorganization correlates with changes in spinal cord microstructure, revealing a systems-level mechanism of neural repair. Full article

This review examines the safety and clinical efficacy of mesenchymal stem/stromal cells (MSCs)-based therapies in patients with spinal cord injury (SCI). The analysis covers 26 clinical studies conducted on patients with varying degrees of the post-SCI neurological deficit. The review highlights the methodology of trials, the source of MSCs, the dosage of cells administered, transplantation methods, patient inclusion criteria, and the methods of evaluating the effectiveness of the therapy. MSC transplantation in SCI was safe and feasible in all the studies summarized in our review. All studies conducted have demonstrated varying degrees of patient improvement and reduction in the severity of neurological deficits. However, further controlled randomized studies on larger numbers of patients are needed to better evaluate the therapeutic efficacy of MS transplantation. The prospects of the enhancement of the efficacy of the SCI cell therapy with MSCs, including their transplantation with other types of stem cells, administration of MSC-derived exosomes, genetic modification of MSCs, use of the MSC- and other-stem-cell-based tissue-engineered scaffolds, and combination of cell therapy with neuromodulation, are discussed. Full article

Background/Objective: Spinal cord injury (SCI) is a life-altering condition representing a major cause of long-term disability and substantial health burden worldwide. In the Middle East, including Saudi Arabia, rapid urbanization and evolving injury patterns may have influenced SCI trends; however, national data remain limited. This study aimed to examine age-standardized trends in SCI incidence, prevalence, and years lived with disability (YLDs) in Saudi Arabia from 1990 to 2021, comparing transport-related and non-transport unintentional injuries, and describing age- and sex-specific SCI patterns in 2021. Methods: Using data from the Global Burden of Diseases (GBD) 2021 study, we conducted a population-based trend analysis for Saudi Arabia from 1990 to 2021, stratified by age, sex, and injury cause. Outcomes included age-standardized incidence, prevalence, and YLD rates per 100,000 population, along with percentage changes, average annual percentage changes, and rate ratios with 95% uncertainty intervals (UIs). Results: Between 1990 and 2021, age-standardized SCI showed a point estimate increase in incidence (25.0%; 95% UI: −28.3 to 116.8) and prevalence (24.3%; 95% UI: 0.8 to 53.4), while YLDs showed a modest rise (1.4%; 95% UI: −44.5 to 83.9). Males experienced greater increases in incidence (31.9%) and prevalence (32.3%) than females. Non-transport unintentional injuries surpassed transport-related causes, accounting for nearly 75% of SCI-related YLDs in 2021. The highest burden occurred among young adult males (highest incidence) and older adults (peak prevalence). Conclusions: The burden of SCI in Saudi Arabia has increased over the past three decades, with a shift toward non-transport unintentional injuries. Because wide uncertainty intervals limit definitive conclusions on trend direction, strengthening injury prevention, rehabilitation, and surveillance programs is crucial to mitigate this growing burden. Full article

Manual wheelchair users with spinal cord injury (SCI) often experience upper-limb strain and pain due to repetitive propulsion. A detachable dual-propulsion add-on device has been developed to mitigate this issue by offering an alternative propulsion mechanism, but its user acceptability and practical benefits must be rigorously evaluated. This study will implement a structured mixed-methods usability assessment of the new device with 30 adult wheelchair users with SCI. The evaluation will combine quantitative surveys, objective task-based performance metrics, and qualitative interviews to capture a comprehensive picture of usability. We will conduct a single-arm mixed-methods protocol using a device-specific 45-item usability questionnaire and semi-structured interviews, followed by convergent triangulation to integrate quantitative scores and qualitative themes. Participants will use the dual-propulsion device in realistic scenarios and then complete a 45-item questionnaire covering effectiveness, efficiency, safety, comfort, and psychosocial satisfaction. In addition, semi-structured interviews will explore users’ experiences, perceived benefits, challenges, and suggestions. During a standardized mobility task course (doorway navigation, ramp ascent, threshold crossing, and 50 m level propulsion), objective performance indicators—including task completion time, task success/error rate, number of lever strokes, and self-selected speed—will be recorded as secondary usability outcomes. The use of both a standardized questionnaire and in-depth interviews will ensure both broad and nuanced assessment of the device’s usability. Data from the survey will be analyzed for usability scores across multiple domains, while interview transcripts will undergo thematic analysis to enrich and validate the quantitative findings. This protocol is expected to provide robust evidence of the device’s usability, inform iterative improvements in its design, and highlight the importance of structured usability evaluations for assistive technologies. Full article

Background: Long pulse width stimulation (LPWS; 120–150 ms) has the potential to stimulate denervated muscles in persons with spinal cord injury (SCI). We examined whether testosterone treatment (TT) + LPWS would increase skeletal muscle size, leg lean mass and improve overall metabolic health in SCI persons with denervation. We hypothesized that one year of combined TT + LPWS would downregulate gene expression of muscle atrophy and upregulate gene expression of muscle hypertrophy and increase mitochondrial health in SCI persons with lower motor neuron (LMN) injury. Methods: Ten SCI participants with chronic LMN injury were randomized into either 12 months, twice weekly, of TT + LPWS (n = 5) or a TT+ standard neuromuscular electrical stimulation (NMES; n = 5). Measurements were conducted at baseline (week 0), 6 months following training (post-intervention 1), and one week following 12 months of training (post-intervention 2). Measurements included body composition assessment using magnetic resonance imaging (MRI) and dual x-ray absorptiometry (DXA). Metabolic profile assessment encompassed measurements of resting metabolic rate, carbohydrate and lipid profiles. Finally, muscle biopsy was captured to measure RNA signaling pathways and mitochondrial oxidative phosphorylation. Results: Compliance and adherence were greater in the TT + NMES compared to the TT + LPWS group. There was a 25% increase in the RF muscle CSA following P1 measurement in the TT + LPWS group. There was a recognizable non-significant decrease in intramuscular fat in both groups. There was a trend (p = 0.07) of decrease in trunk fat mass following TT + LPWS, with an interaction (p = 0.037) in android lean mass between groups. There was a trend (p = 0.08) in mean differences in DXA-visceral adipose tissue (VAT) between groups at P1 measurements. For genes targeting muscle atrophy, TT + LPWS showed a trending decline in MURF1 and FOXO3 genes returning to similar levels as TT + NMES before 12 months. Conclusions: These pilot data demonstrated the safety of applying LPWS in persons with SCI. Six months of TT + LPWS demonstrated increases in rectus femoris muscle CSA. The effects on muscle size were modest between groups. Signaling pathway analysis suggested downregulation of genes involved in muscle atrophy pathways. Future clinical trials may consider a home-based approach with more frequent applications of LPWS. Full article

Manual wheelchair propulsion is a frequent activity among people with spinal cord injury (SCI) and is linked to upper limb loading and shoulder pain. We compared propulsion strategies at cadences of 30 and 50 bpm. Kinematics and surface electromyography (EMG) were recorded across the propulsion cycle, push/recovery phases, and events. Ranges of motion for shoulder flexion/extension, adduction/abduction, and elbow flexion/extension did not differ significantly, although ROM tended to be smaller at 50 bpm; push angle was larger at 50 bpm but not significant. Propulsion cycle duration was shorter at 50 bpm (p < 0.001). Push duration was similar, but its proportion of the cycle increased at 50 bpm (p < 0.001). Recovery duration was shorter at 50 bpm (p < 0.001), yet its cycle proportion increased (p < 0.01). EMG showed cadence-specific redistribution: higher activity at 50 bpm at preparation (anterior deltoid, pectoralis major, biceps brachii, upper trapezius; p < 0.01) and at contact (posterior deltoid; p < 0.05); higher biceps brachii at release and higher anterior deltoid at end-range extension at 30 bpm (both p < 0.05). Cadence manipulation reorganized timing and muscle demands without large ROM changes, supporting rhythm-based training and propulsion design to mitigate shoulder loading. Full article

Background/Objectives: To perform a physicochemical characterization of urine and sediment in intermittent catheterization (IC) users and evaluate the impact of IC with micro-hole zone catheters (MHZC) and conventional two-eyelet catheters (CEC). Methods: Analysis of anonymized urine samples collected from four IC user groups with lower urinary tract dysfunction (LUTD): Newly diagnosed individuals with spinal cord injury (SCI) from an inpatient SCI clinic (A), and community-based IC users with SCI (B), multiple sclerosis (MS) (C), or other conditions than SCI or MS (D). Urine analysis included physicochemical properties, bacterial load, and sediment size, both after collection and following passage through MHZC and CEC. Results: Urine samples from 53 participants were analyzed (groups A: 11, B: 11, C: 9, D: 22). The physicochemical properties of urine were similar to reference values despite the prevalence of bacteriuria ranging from 54.5% to 77.3%. The median [99th percentile] sediment size in the total group was 8.6 µm [50.7 µm] and 8.5 µm [54.1 µm] for group A, 9.2 µm [40.3 µm] for group B, 7.9 µm [48.3 µm] for group C, and 8.9 µm [50.3 µm] for group D. Following catheter passage, the median sediment size for the total group was 8.9 µm with the MHZC and 8.9 µm with the CEC. Conclusions: This two-part study initially presented a novel approach to characterizing urine samples, including sediment from IC users, and, thereafter, an in vitro experiment using the samples to test sediment passage through MHZC and CEC. The results indicated similar urine properties and sediment sizes across groups and did not suggest differences or issues relating to urine and sediment passage through these IC technologies for these groups. Full article

Background/Objectives: Spinal cord injury represents a devastating neurological condition affecting approximately 27 million individuals globally, with particularly severe impacts on sexual function. Sexual dysfunction in SCI patients is multifactorial, with prevalence rates reaching 80–90% across different populations. In low- and middle-income countries, sexual health remains critically neglected in rehabilitation settings due to cultural barriers, inadequate healthcare infrastructure, and limited clinician training. Tunisia, with an estimated 31,000 SCI cases, lacks comprehensive data on sexual dysfunction prevalence and healthcare communication patterns in this vulnerable population. Based on identified research gaps, our study aimed to (i) assess the prevalence and severity of sexual dysfunction among Tunisian SCI patients using validated assessment tools, (ii) identify clinical and demographic factors associated with sexual dysfunction, and (iii) evaluate the current state of sexual health communication and rehabilitation services. Methods: A cross-sectional observational study was conducted at Sahloul University Hospital, Sousse, Tunisia, between July and September 2025. Fifty-one adults with chronic SCI (≥12 months post-injury) were recruited through consecutive sampling. Sexual function was assessed using the International Index of Erectile Function (IIEF) for men and the Female Sexual Function Index (FSFI) for women. Additional assessments included demographic data, injury characteristics using the American Spinal Injury Association Impairment Scale, pain evaluation, functional status, psychological well-being, and sleep quality. Statistical analysis included descriptive statistics, Spearman correlations, and significance testing (p < 0.05). Results: Sexual dysfunction affected 84.3% of participants (43/51), with 88.5% of men experiencing moderate-to-severe erectile dysfunction (median IIEF: 12 [7–36.25]) and 80% of women reporting sexual dysfunction (median FSFI: 7.2 [4–24.25]). Severe dysfunction (FSFI ≤ 10) was present in 56% of female participants. Sexual dysfunction correlated significantly with urinary incontinence (p = 0.045) and with measures of functional independence, including SCIM-III (ρ = 0.466, p = 0.016) and FIM (ρ = 0.569, p = 0.002) among men, and SCIM-III (ρ = 0.469, p = 0.018) and FIM (ρ = 0.495, p = 0.012) among women, indicating moderate positive associations between sexual and functional outcomes. Only 11.5% of men achieved normal erectile function (IIEF ≥48). Psychological factors (HAD-S) and pain scores (NRS, DN4) were not significantly associated with sexual function. A total of 92% of patients reported never discussing sexual health with their healthcare providers, and 100% lacked access to dedicated sexual rehabilitation services, underscoring severe care and communication gaps in the Tunisian SCI rehabilitation system. Conclusions: Sexual dysfunction is highly prevalent among Tunisian spinal cord injury patients and is closely associated with reduced functional independence and urinary issues. Despite its significant impact, sexual health remains largely neglected in rehabilitation care. These findings highlight an urgent need to integrate sexual health into national rehabilitation protocols through provider training, multidisciplinary services, and culturally sensitive education. Systematic sexual health assessment and rehabilitation should be considered essential to improving the quality of life and restoring dignity for affected individuals. Full article

Spinal cord injury (SCI) impairs motor function and requires rigorous rehabilitative therapy, motivating the development of approaches that are engaging and customizable. Virtual reality (VR) motor training with augmented sensory feedback (ASF) offers a promising pathway to enhance functional outcomes, yet it remains unclear how ASF modalities affect performance and underlying psychophysiological states in persons with SCI. Five participants with chronic incomplete cervical-level SCI controlled a virtual robotic arm with semi-isometric upper-body contractions while undergoing ASF training with either visual feedback (VF) or combined visual plus haptic feedback (VHF). Motor performance (pathlength, completion time), psychophysiological measures (EEG, EMG, EDA, HR), and perceptual ratings (agency, motivation, utility) were assessed before and after ASF training. VF significantly reduced pathlength (−12.5%, p = 0.0011) and lowered EMG amplitude (−32.5%, p = 0.0063), suggesting the potential for improved motor performance and neuromuscular efficiency. VHF did not significantly improve performance, but trended toward higher cortical engagement. EEG analyses showed VF significantly decreased alpha and beta activity after training, whereas VHF trended toward mild increases. Regression revealed improved performance was significantly (p < 0.05) associated with changes in alpha power, EMG, EDA, and self-reported motivation. ASF type may differentially shape performance and psychophysiological responses in SCI participants. These preliminary findings suggest VR-based ASF as a potent multidimensional tool for personalizing rehabilitation. Full article

Background and Objectives: Neuropathic pain is a prevalent and disabling consequence of spinal cord injury (SCI), adversely affecting physical function, psychological health, social engagement, and overall quality of life. Objectives: This study aimed to determine the prevalence of neuropathic pain in patients with spinal cord injury (SCI) and to examine its associations with clinical and demographic factors, quality of life, depression, and anxiety. Materials and Methods: Eighty-four patients with spinal cord injury (SCI) who were admitted to the Department of Physical Medicine and Rehabilitation and followed up at the rehabilitation outpatient clinic of Dicle University Faculty of Medicine (Diyarbakır, Turkey) were included in the study. Neurological status was assessed using the American Spinal Injury Association (ASIA) scale. Functional ambulation was evaluated with the Walking Index for Spinal Cord Injury (WISCI) and the Functional Ambulation Scale (FAS), while independence was measured using the Spinal Cord Independence Measure, version 3 (SCIM-III). Quality of life was assessed with the Short Form-36 (SF-36), and depression and anxiety were evaluated using the Beck Depression Inventory (BDI) and Beck Anxiety Inventory (BAI), respectively. The severity of neuropathic pain, fatigue, and paresthesia was assessed using the Visual Analog Scale (VAS) and the Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) questionnaire. Results: Neuropathic pain was observed in 41.7% of patients. No significant differences were found in age, sex, or marital status between patients with and without neuropathic pain. Patients with neuropathic pain had significantly higher Beck Anxiety Inventory (BAI) scores and lower scores in several Short Form-36 (SF-36) domains, including vitality, bodily pain, and emotional well-being. Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) scores were positively correlated with Visual Analog Scale (VAS) fatigue and BAI scores, and negatively correlated with SF-36 domains such as vitality, general health, and bodily pain. Conclusions: Neuropathic pain is a common and debilitating complication following spinal cord injury (SCI). It is closely associated with reduced quality of life and heightened psychological distress, particularly anxiety. Early recognition and effective management of neuropathic pain are crucial for optimizing functional recovery and enhancing psychosocial well-being in patients with SCI. Full article

Virtual reality (VR) offers built-in wearable sensor-based tracking capabilities. Current research focusses on position and orientation error, with limited results on more clinically relevant metrics, such as joint angles. This leads us to our first objective, to characterize the accuracy of upper extremity VR motion capture. Since the intent is for clinical translation, our second objective is to compare the errors across people identified as healthy controls and people who had experienced a spinal cord injury (SCI). Spatially and temporally synced VR and infrared motion capture data were collected during a variety of custom VR Beat Saber levels. Error values were found with infrared motion capture as the ground truth. The median RMSE was found to be below 7° for shoulder horizontal adduction and elbow flexion and 5° for shoulder elevation and wrist joint metrics. The percentage median error for the range of motion was found to be below 30%, 15%, and 5% for the frontal wrist, sagittal wrist, and all other joints, respectively. Larger standard deviations suggest that repetitions are needed to obtain reliable measurements. No statistical difference in any error metric was found between the control cohort and SCI cohort, providing evidence for clinical translation for post-SCI treatment. Full article

Traumatic spinal cord injury (SCI) is a devastating complication of trauma, causing long-term disability and significant socioeconomic burden. Beyond the primary mechanical insult, secondary injury cascades involving apoptosis, oxidative stress, and inflammation amplify tissue damage. MicroRNAs (miRNAs) regulate these processes at the post-transcriptional level, yet data on circulating miRNAs in human SCI remain scarce. This study aimed to characterize acute plasma miRNA expression patterns in isolated traumatic SCI that may indicate SCI-specific signatures. Plasma was collected from five SCI patients at admission and 48 h post-injury and five healthy controls (HCs), and next-generation sequencing (NGS) was performed on plasma RNAs. Differentially expressed miRNAs were identified, and selected candidate miRNAs were validated by droplet digital PCR (ddPCR) in an expanded cohort of SCI patients, polytrauma patients without neurotrauma (PT), and HC (each n = 8). Pathway enrichment and validated target analysis were performed to assess biological relevance of candidate miRNAs. At emergency room admission, 46 miRNAs were differentially expressed in SCI plasma (18 upregulated, 28 downregulated). By 48 h, a global downregulation was observed, with 47 miRNAs significantly decreased compared with HC. ddPCR validation revealed markedly stronger suppression of miR-182-5p, miR-190a-5p, miR-144-5p, and miR-30c-5p expression levels in SCI compared with PT. Pathway analysis indicated enrichment of mitochondrial oxidative phosphorylation pathways, and target prediction suggested that the identified miRNAs may be linked to neuroprotective and regenerative functions. Our findings demonstrate early and profound alterations in circulating miRNAs after acute SCI. The downregulation of the identified miRNAs may reflect maladaptive changes that promote neuroinflammation and hinder axonal regeneration, although the exact functional consequences remain to be clarified. These data suggest that circulating miRNAs could hold promise as diagnostic and prognostic biomarkers and, potentially, as therapeutic targets to influence secondary injury processes. However, given the exploratory nature and limited sample size of this study, the findings should be validated in larger, sufficiently powered cohorts to robustly delineate differences between patient groups. Full article